Contributions
Abstract: PB1560
Type: Publication Only
Session title: Hodgkin lymphoma - Clinical
Background
Combined modality therapy including ABVD and radiotherapy (RT) has been traditionally the treatment of choice for limited-stage Hodgkin lymphoma (HL) (I/II). The long-term side effects of RT are still notable and consist the main reason for the attempt to exclude it from the treatment algorithm in a group of patients that are mostly young and, thus, vulnerable to late-onset neoplastic and cardiovascular complications. Recently, in 2017, the EORTC H10 study demonstrated that RT can be safely omitted in case of a strictly negative interim PET (iPET) [roughly corresponding to Deauville-5-point scale score (D5PSS) 1-2], with a statistically significant but numerically negligible loss in disease control of about 2-3%, especially in patients with early unfavorable disease. On the contrary, in patients who remain iPET-positive, RT is preserved and chemotherapy can be intensified with excellent results.
Aims
The aim of this study was the initial evaluation of the results of the above strategy, which was adopted in our Center in 2018, as most of the relapses occur within the first 2 years from diagnosis and therefore, a preliminary assessment of the safety of RT omission in regard to disease control can be performed in a real-life setting.
Methods
52 patients <50 years old with a median follow-up of 18 months were retrospectively evaluated. Since the beginning of 2018 we used the aforementioned therapeutic strategy in patients with favorable or unfavorable limited-stage disease with mediastinal involvement. On the other hand, RT was maintained in patients without mediastinal involvement, those with iPET D5PSS 3 as well as those with D5PSS 4-5, who received BEACOPP-escalated and RT, and in patients >50 years old, who are potentially less susceptible to long-term complications.
Results
Patients <50 years with mediastinal involvement: Among 41 patients included, 31 had early unfavorable and 10 early favorable HL according to EORTC. Among 24 patients who achieved D5PSS-1/2 (59%) only 3 received RT. The 2-year Progression-Free Survival (PFS) was 96% with only one event of primary refractory disease upon restaging that could not have been avoided with RT. Among 11 patients (27%) who achieved D5PSS 7 received RT with no relapses observed in this group so far. iPET remained positive with D5PSS-4/5 in 6 patients (15%), 5 of whom were switched to BEACOPP-esc and RT. The 1-year PFS was 50%. Patients<50 years without mediastinal involvement: Among 11 patients included, 10 had early favorable and 1 early unfavorable HL according to EORTC. Among 9 patients (82%) who achieved D5PSS-1/2/3, 8 received RT. No relapses were observed. iPET was positive with D5PSS-4/5 in 2 patients that were treated with BEACOPP-esc and RT without any relapse so far.
Conclusion
These initial results demonstrate that when RT is omitted following a strictly negative iPET, the relapse rate remains low and absolutely acceptable in the short-term, which is the highest-risk time period. In fact, in this situation the only observed failure event could not have been avoided with RT. However, the question whether RT remains necessary for patients with D5PSS-3 still exists. No safe conclusions can be made so far in regard to the intensification of therapy with BEACOPP-esc in the small subgroup with clearly positive iPET. These results encourage the continuation of this therapeutic strategy based on H10 study, in order to eliminate the long-term side effects of radiotherapy. Further observation and recruitment of much more patients in this real-life setting is scheduled.
Keyword(s): Hodgkin's lymphoma, PET, Radiotherapy
Abstract: PB1560
Type: Publication Only
Session title: Hodgkin lymphoma - Clinical
Background
Combined modality therapy including ABVD and radiotherapy (RT) has been traditionally the treatment of choice for limited-stage Hodgkin lymphoma (HL) (I/II). The long-term side effects of RT are still notable and consist the main reason for the attempt to exclude it from the treatment algorithm in a group of patients that are mostly young and, thus, vulnerable to late-onset neoplastic and cardiovascular complications. Recently, in 2017, the EORTC H10 study demonstrated that RT can be safely omitted in case of a strictly negative interim PET (iPET) [roughly corresponding to Deauville-5-point scale score (D5PSS) 1-2], with a statistically significant but numerically negligible loss in disease control of about 2-3%, especially in patients with early unfavorable disease. On the contrary, in patients who remain iPET-positive, RT is preserved and chemotherapy can be intensified with excellent results.
Aims
The aim of this study was the initial evaluation of the results of the above strategy, which was adopted in our Center in 2018, as most of the relapses occur within the first 2 years from diagnosis and therefore, a preliminary assessment of the safety of RT omission in regard to disease control can be performed in a real-life setting.
Methods
52 patients <50 years old with a median follow-up of 18 months were retrospectively evaluated. Since the beginning of 2018 we used the aforementioned therapeutic strategy in patients with favorable or unfavorable limited-stage disease with mediastinal involvement. On the other hand, RT was maintained in patients without mediastinal involvement, those with iPET D5PSS 3 as well as those with D5PSS 4-5, who received BEACOPP-escalated and RT, and in patients >50 years old, who are potentially less susceptible to long-term complications.
Results
Patients <50 years with mediastinal involvement: Among 41 patients included, 31 had early unfavorable and 10 early favorable HL according to EORTC. Among 24 patients who achieved D5PSS-1/2 (59%) only 3 received RT. The 2-year Progression-Free Survival (PFS) was 96% with only one event of primary refractory disease upon restaging that could not have been avoided with RT. Among 11 patients (27%) who achieved D5PSS 7 received RT with no relapses observed in this group so far. iPET remained positive with D5PSS-4/5 in 6 patients (15%), 5 of whom were switched to BEACOPP-esc and RT. The 1-year PFS was 50%. Patients<50 years without mediastinal involvement: Among 11 patients included, 10 had early favorable and 1 early unfavorable HL according to EORTC. Among 9 patients (82%) who achieved D5PSS-1/2/3, 8 received RT. No relapses were observed. iPET was positive with D5PSS-4/5 in 2 patients that were treated with BEACOPP-esc and RT without any relapse so far.
Conclusion
These initial results demonstrate that when RT is omitted following a strictly negative iPET, the relapse rate remains low and absolutely acceptable in the short-term, which is the highest-risk time period. In fact, in this situation the only observed failure event could not have been avoided with RT. However, the question whether RT remains necessary for patients with D5PSS-3 still exists. No safe conclusions can be made so far in regard to the intensification of therapy with BEACOPP-esc in the small subgroup with clearly positive iPET. These results encourage the continuation of this therapeutic strategy based on H10 study, in order to eliminate the long-term side effects of radiotherapy. Further observation and recruitment of much more patients in this real-life setting is scheduled.
Keyword(s): Hodgkin's lymphoma, PET, Radiotherapy